Prolonged time to pregnancy is associated with a greater risk of adverse outcomes

doi:10.1016/j.fertnstert.2009.10.058

Fertility and Sterility

Volume 94, Issue 3, August 2010, Pages 1148-1151

https://doi.org/10.1016/j.fertnstert.2009.10.058 Get rights and content

Births with known time to pregnancy (TTP) during the period 1989–2007 (n = 17,114) were analyzed to investigate associations between TTP and pregnancy outcome among couples that conceived spontaneously. The adjusted odds ratio (95% confidence interval) for poor neonatal health, including low Apgar score, low umbilical vein pH, and need for neonatal intensive care, was 1.51 (1.09–2.09) in women who had a TTP of 25–36 months and 1.60 (1.18–2.19) in women who had a TTP of ≥37 months compared with women with a TTP of 0–6 months.

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Acknowledgments

The authors' sincerest thanks go to electronic database designer Olavi Kauhanen for maintaining the obstetric registers and for providing help in data management and advice about the analyses.

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Cited by (30)

Comparative efficacy of acupuncture-related interventions for tubal obstructive infertility: A systematic review and Bayesian meta-analysis of randomized controlled trials
2023, Complementary Therapies in Medicine
Tubal obstructive infertility (TOI) is a challenging condition affecting many women worldwide. Acupuncture and herbal medicine have emerged as potential therapeutic options for enhancing fertility outcomes in these patients. However, the evidence regarding their efficacy remains inconclusive, necessitating a comprehensive systematic review and meta-analysis.
Computer searches were conducted in PubMed, Cochrane, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), VIP Information, Wanfang Database, and China Biology Medicine (CBM) databases to retrieve relevant literature on the efficacy and safety of acupuncture and related therapies for the treatment of tubal obstructive infertility. The search period extended from the inception of the databases to December 2022. Two researchers independently screened the literature based on strict inclusion criteria, extracted relevant data, and utilized Cochrane Collaboration tools and the Jadad scale to comprehensively assess the quality of the included studies. Subsequently, pairwise meta-analysis and network meta-analysis were performed using statistical software such as StataSE and Rstudio, and graphical representations were generated to present the results.
The network meta-analysis included 1580 articles, with 23 meeting the criteria. These studies involved 2355 patients and explored 13 intervention measures. Acupuncture-related therapies outperformed control interventions in improving pregnancy rates, tubal patency rates, and overall effectiveness while demonstrating a lower incidence of adverse events. EA+CHM was identified as the most effective for pregnancy rates, MOX for tubal patency rates, and MOX+AP for overall effectiveness. The safety profile of acupuncture-related interventions was acceptable. These findings support acupuncture-related therapies as effective and safe options for tubal obstructive infertility management. Further high-quality research is needed to validate and expand upon these results.
These findings offer novel treatment strategies for acupuncture-related interventions, providing practitioners with evidence-based guidance. Addressing limitations through future research is crucial, including diverse literature, emphasizing higher-quality RCTs, and exploring a broader range of interventions with long-term follow-up data. Systematic assessment of adverse events, standardized techniques, and robust ranking methods should be considered.
Time to pregnancy and perinatal outcomes in a cohort of spontaneous pregnancies
2022, Sexual and Reproductive Healthcare
Citation Excerpt :
Both woman’s age and self-reported TTP have been related to the prognosis in reproductive success. Some authors have observed that an increase of both age and TTP is related to a higher frequency of maternal complications that develop during pregnancy, such as hypertensive disorders, preeclampsia, premature labor, gestational diabetes (GD), fetal growth restriction (FGR), labor complications such as puerperal hemorrhage and/or neonatal complications [3–7]. Preeclampsia complicates 2–8 % of pregnancies worldwide, preterm premature rupture of membranes (PPROM) up to 8 %, clinically relevant hemorrhage occurs in 5–15 % of deliveries, according to data from the Spanish Society of Gynecology and Obstetrics (SEGO) https://sego.es/documentos/progresos/v63-2020/n4/GAP-Trastornos%20hipertensivos%20gestacion.pdf.
Obstetric and perinatal outcomes depend not only on care during pregnancy, as there is an increasing evidence of their relationship with preexisting conditions. Woman’s age and time to pregnancy (TTP) have been related to the prognosis in reproductive success, but TTP could influence fetal well-being and newborn. According to the World Health Organization, 48 million couples have subfertility globally.
We analyzed the relationship between TTP and obstetric (premature labor, preeclampsia…), labor (type of delivery, postpartum hemorrhage…), and neonatal outcomes (low birth weight…) in a cohort of 190 spontaneous gestations. Subfertility is a disease defined by the failure to achieve a pregnancy after 12 months of regular unprotected sexual intercourse.
TTP was >12 months in 23.1 % (95 % CI = 17.57–29.55), however, no correlation was found with the perinatal outcomes (p = 0.24). We observed that 45.2 % of subfertile women had obstetric complications, 13.2 % labor complications, and 34.2 % neonatal complications, whereas non-subfertile women had 29.4 %, 21.0 %, and 21.0 %, respectively. Half of pregnancies have at least one adverse outcome, and obstetric complications were the most frequent.
Subfertility condition may appear in up to a fifth of our couples. Subfertility may behave as a mild risk factor for adverse perinatal outcomes. Obstetric or perinatal complication may be expected in up to half of the cases. Subfertile women ≥ 35 years of age have a 3-fold increase in their risk of having an obstetric complication when compared to non-subfertile women of the same age.
Adverse obstetric and perinatal outcome with in vitro fertilization technology: A French nationwide population-based study
2020, Gynecologie Obstetrique Fertilite et Senologie
L’objectif de cette étude était de quantifier les risques de morbidité maternelle et périnatale en fécondation in vitro (FIV) par rapport aux grossesses non issues de FIV sur une cohorte nationale française récente.
Les données étaient issues du système d’information des données d’hospitalisation incluant toutes les grossesses ayant conduit à un accouchement et les naissances de 2013 à 2016. Les risques d’accouchement prématuré, de morbidité maternelle (thrombose veineuse et artérielle, diabète gestationnel, troubles vasculaires, placenta praevia, hématome rétroplacentaire), d’hypotrophie et de malformation congénitale ont été comparés entre les deux groupes en analyse univariée et multivariée après ajustement sur les caractéristiques des femmes (l’âge, la primiparité, l’obésité, la dépendance au tabac, les antécédents de diabète ou d’hypertension artérielle), les accouchements multiples et le sexe des enfants.
Au total, 2 875 662 grossesses ayant conduit à un accouchement et 2 922 712 naissances ont été analysées, dont 49 224 (1,7 %) issues de FIV avec transfert d’embryons frais. En analyse multivariée, tous les risques de morbidité étaient significativement plus élevés en FIV : les accouchements prématurés (OR_ajusté = 1,28 ; IC₉₅ _% = 1,24–1,32), la morbidité maternelle (OR_ajusté = 1,24 ; IC₉₅ _% = 1,21–2,28) (principalement pour les thromboses veineuses dans les accouchements multiples, le placenta praevia et les hématomes rétroplacentaires). Les risques d’hypotrophie (OR_ajusté = 1,13 ; IC₉₅ _% = 1,10–1,16) et de malformations congénitales (OR_ajusté = 1,11 ; IC₉₅ _% = 1,05–1,17) étaient faiblement augmentés.
Les résultats de cette première étude portant sur un large effectif de naissances récentes en France confirment qu’il existait une augmentation des risques de morbidité maternelle et périnatale en FIV. Ces risques étaient comparables à ceux publiés dans la littérature internationale. Cette étude constitue le point de départ d’une surveillance de la morbidité maternelle et périnatale en FIV.
The objective of this study was to quantify the risk of maternal and perinatal morbidity with in vitro fertilization (IVF) technology compared to non-IVF pregnancies in a recent French national cohort.
The data was extracted from the hospital information data system, including all pregnancies with a delivery from 2013 to 2016. The risks of preterm birth, maternal morbidity (venous and arterial thrombosis, gestational diabetes, vascular disorders, placenta previa, placenta abruption), hypotrophy and congenital malformation were compared in both groups in univariate and multivariate analysis after adjustment on the characteristics of women (age, parity, obesity, tobacco dependence, history of diabetes or high blood pressure), multiple deliveries and sex of children.
In all, 2,875,662 pregnancies and 2,922,712 births were analyzed, of which 49,224 were derived from IVF (1.7%). In multivariate analysis, all risks were significantly higher in IVF: premature deliveries (OR_ajusted = 1.28; CI_95% = 1.24–1.32), maternal morbidity (OR_ajusted = 1.24; CI_95% = 1.21–2.28), (mainly for thrombosis venous, placenta previa and placenta abruption). The risks of hypotrophy (OR_ajusted = 1.13; CI_95% = 1.10–1.16) and congenital malformations (OR_ajusted = 1.11; CI_95% = 1.05–1.17) were slightly increased.
The results of this study on a large cohort of recent births in France confirm that there was an increased risk of maternal and perinatal morbidities in IVF. These risks were similar to those published in the international literature. This study is the starting point for a forthcoming surveillance.
Effects of in vitro fertilization and maternal characteristics on perinatal outcomes: A population-based study using siblings
2016, Fertility and Sterility
Citation Excerpt :
Regarding our secondary outcome measures, maternal characteristics (including subfertility) were associated with perinatal mortality, a shorter gestational duration, and increased spontaneous preterm delivery rates. Our findings are in line with the increasing amount of studies that have described an association between subfertility and obstetric and neonatal problems (5–16). Unlike other studies, we distinguished spontaneous preterm delivery from iatrogenic preterm delivery because IVF pregnancies may more often involve an anxious patient and/or a cautious doctor, which could influence the prematurity outcome.
To study birthweight in consecutively born sibling singletons conceived with and without in vitro fertilization (IVF) to disentangle the effects of maternal characteristics from those of the IVF treatment itself.
Population-based study.
Not applicable.
Firstborn and secondborn children from a 9-year birth cohort (1999–2007) comprising of 272,551 women who conceived two siblings.
No intervention; children were conceived naturally or through IVF.
Birthweight.
The study included 545,102 children born by natural conception (NC) or IVF with the data set obtained from the population-based Netherlands Perinatal Registry (PRN) containing information on pregnancies, deliveries, and neonatal outcomes. We used two approaches: [1] the intersibling approach and [2] the sibling-ship approach. In the first approach we included children born to four groups of mothers who conceived in the following order (numbers indicate birth order): NC1-NC2 (reference, n = 254,721), IVF1-NC2 (n = 1342), NC1-IVF2 (n = 471), and IVF1-IVF2 (n = 687). Several comparisons were made to interpret the effects of IVF and maternal characteristics separately. In the second approach, perinatal outcomes of IVF children (n = 1,813) were compared with those of their NC siblings (n = 1,813). The intersibling analyses suggested an association between maternal characteristics and a lower birthweight, with estimates of the maternal effect ranging from −7 g (95% CI, −40; 26) to −101 g (95% CI, −170; −32). Neither the intersibling analyses nor the sibling-ship analyses indicated an additional adverse effect of IVF treatment itself.
Maternal characteristics of subfertile women are associated with a lower birthweight. In vitro fertilization treatment itself does not additionally contribute to a lower birthweight in the offspring.
Assisted reproduction: Ethical and legal issues
2014, Seminars in Fetal and Neonatal Medicine
Citation Excerpt :
Conversely, the culture of embryos up to day 5 of development has been associated with a greater incidence of perinatal morbidity when conception has occurred after a fresh embryo transfer [88–90]. The question remains as to whether suboptimal pregnancy outcomes are related to the underlying infertility of the couples, whether they are associated with intrinsic effects from certain IVF procedures, such as hormonal stimulation, embryo culture media, micromanipulation techniques, or whether they are due to a combination of patient and procedure effects [88,91,92]. Although the vast majority of babies born after IVF are found to be healthy, efforts should be made to continue to document short- and long-term health outcomes of the offspring and to accurately inform and update couples on the results of this surveillance [93].
Since inception, the use of assisted reproductive technologies (ART) has been accompanied by ethical, legal, and societal controversies. Guidelines have been developed to address many of these concerns; however, the rapid evolution of ART requires their frequent re-evaluation. We review the literature on ethical and legal aspects of ART, highlighting some of the most visible and challenging topics. Of specific interest are: reporting of ART procedures and outcomes; accessibility to ART procedures; issues related to fertility preservation, preimplantation genetic testing, gamete and embryo donation, and reproductive outcomes after embryo transfer. Improvements in ART reporting are needed nationally and worldwide. Reporting should include outcomes that enable patients to make informed decisions. Improving access to ART and optimizing long-term reproductive outcomes, while taking into account the legal and ethical consequences, are challenges that need to be addressed by the entire community of individuals involved in ART with the assistance of bioethicists, legal counselors, and members of society in general.
Prevalence of infertility in the United States as estimated by the current duration approach and a traditional constructed approach
2013, Fertility and Sterility
To estimate the prevalence of infertility using a current duration approach for comparison with a traditional constructed measure.
Cross-sectional survey.
Not applicable.
A nationally representative sample of females aged 15–44 years.
None.
Infertility prevalence estimated by two approaches: [1] a constructed measure derived from questions on sexual activity, contraception, relationship status, and pregnancy, and [2] a measure based on estimated time to pregnancy derived from the respondents’ current duration of pregnancy attempt (i.e., current duration approach). Associations with self-reported descriptive characteristics using weighted logistic regression or parametric survival models for each respective approach.
Infertility prevalence was approximately twofold higher using the current duration approach (15.5%; 95% confidence interval 8.6%–27.5%) vs. the constructed measure (7.0%; 95% confidence interval 6.2%–7.8%). Both methods identified similar patterns of increasing age, lower education, nulliparity, and history of gynecologic disorders as being associated with measures of impaired fecundity, whereas opposing patterns were seen for racial/ethnic identification and poverty status.
Infertility prevalence based on a current duration approach was consistent with other US prospective cohort studies with preconception enrollment. These findings underscore the importance of definition and methodologic approach for estimating the prevalence of infertility.

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: K.R. has nothing to disclose. M.H. has nothing to disclose. M.H. has nothing to disclose. S.H. has nothing to disclose.

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CorrespondenceProlonged time to pregnancy is associated with a greater risk of adverse outcomes

Section snippets

Acknowledgments

Fertil Steril

Fertil Steril

Am J Prev Med

Semin Neonatol

Fertil Steril

Fertil Steril

Placenta

Best Pract Res Clin Obstet Gynaecol

Fertil Steril

Eur J Obstet Gynecol Reprod Biol

Fertil Steril

Regional differences in waiting time to pregnancy: pregnancy-based surveys from Denmark, France, Germany, Italy and Sweden

Hum Reprod

Age-related fertility decline: a committee opinion

Fertil Steril

Factors affecting time to pregnancy

Hum Reprod

The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review

Hum Reprod Update

Correspondence
Prolonged time to pregnancy is associated with a greater risk of adverse outcomes